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The fact that River Blindness can now be controlled,
offers hope for other medical problems
Mrs. Colette Abogo is a sixty-year-old grandmother living in Yambassa Village, Bokito District, some 110 kms west of Yaounde. For a long time she suffered from severe itching and lesions of the eye, all symptoms of the onslaught of River Blindness (Onchocerciasis). Fortunately, she was able to receive a dose of Mectizan, free-of-charge, from the Carter Foundation, an American NGO working in Cameroon under the aegis of the Public Health Ministry. This prevented the disease from reaching its peak when irreversible blindness would have occurred.
In October 2003, Mrs. Abogo received the 250 millionth dosage of Mectizan. This took place during a ceremony in the presence of 2,000 Bokito villagers; Alim Hayatou, the Secretary of State for Public Health; representatives from the Carter Foundation and other NGOs and organizations working in Cameroon. After the ceremony, Colette told TV reporters from the national television service: «I was suffering a great deal both from the physical effects of the disease and from the thought I couldn’t be cured. I can now start cultivating my field and looking after my family».
The number of Cameroonian villagers who, like Mrs. Abogo, need treatment for River Blindness, is now decreasing. Ever since the 1970s, a Onchocerciasis Control Programme has been organised in the country’s three northern provinces where the disease is most prevalent (especially in Mbam administrative district which has two large rivers, the Sanaga and Mbam). The present Control Programme came to an end in November 2003. The World Health Organization (WHO) estimates that this campaign made it possible to avoid 450,000 new cases. About 1.2 million villagers were thus protected from the ravages of this terrible disease. Now the danger has disappeared and thousands of farmers in Mbam and the north have once again started to cultivate crops on the fertile land alongside the river banks. These areas could provide enough food to feed 3 million people.
Mrs. Helene Mambu Ma Disu is the WHO‘s local representative. She notes that the Control Programme’s achievements has «encouraged all of us working in the public health sector to dream of the day when we can find a solution to help the poorest of the poor among Cameroon’s people».
Mr. Hayatou describes the Control Programme as «an outstanding success in the fight against disease. It’s a shining example of what could be achieved by similar programmes against other diseases which hinder our country’s development».
A debilitating scourge
During the last few years, Onchocerciasis claimed approximately 100,000 victims in Cameroon and caused almost 10% of all cases of blindness. Most cases of blindness are found in the Central, Adamaoua, North and Far North regions. The Public Health Ministry says that «nearly 28% of the population in these regions suffer from River Blindness».
Onchocerciasis is caused by the Onchocerca volvulus, a parasitic worm that lives for up to 14 years in the human body. Each adult female worm produces millions of microscopic larvae that migrate throughout the body. The larvae produced in one person are carried to another by the blackfly, which in West Africa belongs to the Simulium damnosum species complex. The blackfly lays it eggs in the water of fast-flowing rivers and streams, hence the disease’s more common name — «River Blindness». When a victim has been bitten, the parasitic worms enter the victim’s body and whilst propagating, cause appalling itching, pain and muscular weakness. When the adult stage is reached, the worms attack the eyes, causing permanent blindness. Sometimes this final stage is reached 30 years after the first bite.
Recently, German scientists affirmed that a bacterium living inside these parasites could be causing River Blindness. If other studies, presently underway at an international level confirm this theory, any new cases of Onchocerciasis will be perhaps easier to treat with current antibiotics. This will further reduce the number of infections and will speed up the effort to entirely eliminate Onchocerciasis.
Onchocerciasis is much more than a health problem. The blackfly multiplies along river banks, in precisely the places where land is extremely fertile. In Cameroon in the 1970s, when the disease was at its hight, nearly 110,000 sq. kms. of fertile land situated along the rivers were abandoned, causing economic losses estimated at 4 billion CFA francs (approximately 6 million euros) per annum. During this time, nearly 278,000 people were infected by the parasite.
A coordinated campaign
The Onchocerciasis Control Programme was officially launched in 1974 and initially encompassed seven countries. In 1986 the programme was extended to include four additional countries, bringing the current total of participating countries to eleven. It is jointly sponsored by WHO, the World Bank, the United Nations Development Programme (UNDP) and the Food and Agriculture Organization (FAO). In addition to the participating countries, the programme is supported by a coalition of more than 20 donor countries and agencies, 40 NGOs and many local rural associations. In 1980, Doctor Ibrahim Samba took over as the Control Programme’s director. 15 years later, he became the WHO‘s regional director for Africa.
The WHO‘s national representative said that by the time the fight against Onchocerciasis had peaked, approximately 800 researchers, doctors and another personnel were working with the Control Programme to tackle the disease’s many aspects. The principal method for controlling Onchocerciasis has been to break the cycle of transmission by aerial spraying of breeding sites with selected insecticides. Thus, blackfly prevalence in the most infected areas has been reduced. With donor assistance, research into appropriate drugs and effective treatment programmes for those who had already contracted Onchocerciasis, has been encouraged.
The WHO‘s Dr. Mambu My-Disu in Yaounde, emphasises that one of the keys of the Control Programme’s success in Cameroon and in other Central African countries, is that many people took part in the campaign. Working together was highly significant and effective. In spite of political conflicts in many countries, the Control Programme was accepted everywhere thanks to its reputation for honesty and efficiency.
One of the main participants in the Control programme was Merck & Co, an American multinational pharmaceutical company. In 1987, Merck & Co, pledged to provide Mectizan at no cost as long as necessary to overcome Onchocerciasis as a public health problem. This drug has been used effectively, but has to be taken over 15 years — the lifespan of the adult parasite — its effectiveness is almost total. According to Merck & Co’s general manager, Raymond Gilmartin, the company «wants to make Mectizan freely available to all those who need it, wherever they are in the world».
In Cameroon, Sight Savers International (SSI) is one of the NGOs authorised to supervise the distribution of drugs, and to provide information and training into avoiding Onchocerciasis. SSI‘s programme director is Mrs Catherine Cross. She says: «For fifty years, this organization has fought against River Blindness and has helped more than 5.5 million people worldwide».
SSI and other organizations have always emphasised the importance of local people’s involvement in the fight against Onchocerciasis. Mrs Cross states: «We train specialists, paramedics and other experts in primary ocular care, so that they know about and can use new procedures when treating people with Onchocerciasis. Their training includes rehabilitation programmes for the sick and for people already blinded by the disease. Local communities with their leaders are also called upon to help in distributing the drugs».
Mrs. Geraldine Logmo is a doctor in the Public Health sector. She says that a sterling example is given by involving ordinary citizens in the fight against Onchocerciasis — an example which could be followed in the fight against other diseases, including HIV/AIDS. «The international community can learn an important lesson from what’s taking place in Cameroon — local authorities and communities must play their part in any such action».
- S. Tetchiada & G. Nguekeng, Cameroon, November 2003 — © Reproduction authorised, with usual acknowledgment
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